Reduce waiting lists, the most complex surgery | Society

Reduce waiting lists, the most complex surgery | Society

Pool in the morning, walk five kilometers in the afternoon, travel a lot, take care of the house. Maria, 69, was not stopped by osteoporosis or her back touched after breast cancer. But that changed when he fell in London in September 2017. Today his world is reduced to TV, ice bags for the knee, more kilos, claim and wait. "I can not go around the block and I have the husband making the purchase".

María lives in Barcelona, ​​she has saddened, she has stooped and she does not want to give her real name "in case they do not operate on me," she says. Each of the 584,018 Spaniards on the waiting list to enter the operating room, according to the latest official data of 2018, suffers pain or limitations despite what happens to him is not considered urgent. They wait 93 days on average. The most bulky group will have hip or knee surgery, just like her. Traumatology is the specialty with the most patients enrolled (157,419), waiting for 111 days. Maria is already going through the year, and after the diagnosis, delays in the resonance and the appointment with the specialist, it took six months.


Source: Ministry of Health.

"Your doctor asks for an endoscopy to find out the cause of a heartburn that is unbearable." And I have been cited for a year, "said Víctor García, a 55-year-old getafense. It diffuses that for every 1,000 citizens there are 43 waiting for a specialist to see them, around one and a half million people with a question mark in their heads, four out of 10 are cited beyond two months.

Waiting lists are the main focus of citizen discontent. Those months awaiting the appointment represent the biggest complaint. The last Sanitary Barometer, of 2018, reveals that 47.7% of respondents believe that wait times have not improved. And one in four (24.3%) believe that they got worse.

Spain is no exception. Moreover, it is below the European average on hold. Surrounding countries are in a similar or worse situation. One in five EU citizens over 15 years of age replied that they could not access medical consultations or treatments for the time of delay, according to the latest data from Eurostat, 2014. It is worth asking if that funnel causing so many sleepless nights has some arrangement.

1. Why are there waiting lists? Because in public health systems in which all citizens are protected, it is practically impossible to reconcile offer (the attending doctors and the operating rooms that there are) and demand (the afflicted ones that require attention), say the specialists consulted. It is accessed depending on the need, not the payment. José Ramón Repullo, head of Planning and Health Economics of the National School of Health, observes: "People get sick when they get sick. It is not predictable. " Urgencies are treated immediately and serious diseases such as cancer, with priority. Thus, scheduled surgeries of lesser severity will be delayed and the doctors' schedules will be modified. The professor of the London School of Economics Joan Costa-Font, who analyzed the Spanish surgical waiting lists for the OECD, assures: "The delay times are the result of prioritization decisions". Juan de Llano-Señorís, director of the Gaspar Casal Foundation, argues: "This is not a car factory, you can plan how many are going to be assembled". The state of health of the population, aging and the technologies that make it easier, safer and without hospitalization certain surgeries (cataracts, arthroscopies ...) influence the fattening of the patients' bag, according to the OECD document.


Over 15 years, in%. 2014 data.

Source: Eurostat.

2. Can you end them? Theoretically, yes, the specialists maintain. "It could be practically eliminated with more resources, but it would imply inefficiencies (empty beds ...) to ensure availability at all times," says Costa-Font. Luigi Siciliani, a researcher in Health Economics and co-editor of the extensive review of surgical waiting lists for the OECD published in 2013, states: "Waiting times are not going to disappear completely, and you probably do not want a system with doctors without work , waiting".

3. With more money, doctors, centers, would it be fixed? It is not so clear. There are OECD countries with high health expenditure, number of beds and doctors above the average with long waiting lists. In fact, in the analysis of the organization, to provide more means in critical peaks, the famous plans of shock, have a weak incidence in tackling them in the long term. "The classic error is to think that you can solve the problem simply by putting more means. But that ignores the part of the demand, which in health is a complex and nebulous concept, "says Siciliani. A survey conducted by Salvador Peiró, director of Health Services Research of the Higher Center for Public Health Research (CSISP) of the Generalitat Valenciana, to 130 senior managers, managers and Spanish experts collected in a study for the Ministry of Health in 2005 it revealed that temporary crash plans were considered the worst measure to contain the delays. "And they are the majority of the measures that are taken", says the expert.

It is true that when there are cuts, and therefore the supply is restricted, as happened in Spain at the height of the crisis, the waiting times go up. Year of the snip, 2012, citizens waited 100 days on average to operate, 27 days more than the previous year.

4. What about patients and doctors? "We feel invisible and mistreated," complains Carina Escobar, president of the Platform for Patient Organizations, an entity that represents the chronically ill. Describe the uncertainty of waiting before diagnosis and in the subsequent pilgrimage. Carmen Flores, of the Ombudsman Association, is surprised, "more than the number of cases, its severity." "And of people who come to us with all the claims made. It is a sign of abandonment, "he adds. Only the last indicators, of 2018, have improved. Spaniards wait 11 days less, but they have not reached the pre-crisis times of around 70 days.

"The doctors have endured the crisis but they are broken," observes José Ramón Repullo, also director of the Training Foundation of the Collegial Medical Organization, "you have to recover muscle." Repullo, as the pediatrician Mariano Sánchez Bayle, spokesman of the Federation of Associations for the Defense of Public Health, believes that it is crucial for the waiting lists to strengthen and strengthen primary care, bolted by the cuts. "The family doctor can address, with more time and fewer cards assigned, many ailments that are referred to the specialist," says the latter. Salvador Peiró also contemplates that option to end that false list generated by the saturation of the outpatient clinics. But almost half of family doctors (38%) have quotas of 1,500 to 2,000 patients.


Source: OECD.

5. What works? In 2013, the OECD reviewed the effectiveness of the 11 strategies used in 13 countries over a period of 10 years. "The key to success, in my opinion," argues Siciliani, the co-editor of the review, "is to combine more means with mechanisms that ensure that demand is under control, which means that maximum waiting times must be introduced with clear penalties when they are not respected The good results in the United Kingdom, Finland, Portugal, Holland and Denmark go in that direction ". Finland decreased its lists with fines to hospitals if they exceeded the maximum time. The Netherlands reduced the average surgical wait to less than five weeks by paying doctors and hospitals according to their performance and increasing free choice and competition between centers. Of course, the health bill grew. Denmark implemented a long list of measures. Portugal introduced an information mechanism for patients with delays in private and public hospitals. Upon completion of 75% of the time committed to surgery, the patient received a vúucher to be operated at any center, public or private.

6. And for Spain? We have to recover resources, says Repullo, and encourage health workers. How? "Taking care of them. Allowing them to extend day, for example. " "With recognition, facilities for research, free days", estimates Sanchez Bayle. But always, they say, with exclusive dedication. "So that the schedule really is fulfilled", maintains Peiró. In the survey that included their report, the experts considered that the three most effective measures are the clinical guidelines for the management of each pathology, the introduction of waiting list objectives with economic incentives and the prioritization of patients according to their condition.

At the same time, the public system must increase its performance. "Use resources intensively and better," emphasizes Sanchez Bayle. For example, reopen beds and extend schedules for testing throughout the day. "The waiting lists would improve by better aligning the resources with more leadership and clinical management", not with economic incentives, the peonage, which is a perverse solution, according to De Llano. "And with transparency, so that patients are informed of the efficiency and wait in all centers." The referral to private healthcare, so often invoked and planned, as the new PP Executive in Andalusia has done in a shock plan, showed a weak effect as a solution in the OECD study.


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